Neighborhood-Level Racial/Ethnic Residential Segregation and Incident Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis
Background—Previous research suggests neighborhood-level racial/ethnic residential segregation is linked to health, but it has not been studied prospectively in relation to cardiovascular disease (CVD).
Methods and Results—Participants were 1,595 non-Hispanic Black, 2,345 non-Hispanic White, and 1,289 Hispanic adults from the Multi-Ethnic Study of Atherosclerosis free of CVD at baseline (ages 45-84). Own-group racial/ethnic residential segregation was assessed using the Gi* statistic, a measure of how the neighborhood racial/ethnic composition deviates from surrounding counties' racial/ethnic composition. Multivariable Cox proportional hazards modeling was used to estimate hazard ratios (HR) for incident CVD (first definite angina, probable angina followed by revascularization, myocardial infarction, resuscitated cardiac arrest, CHD death, stroke, or stroke death) over 10.2 median years of follow-up. Among Blacks, each standard deviation increase in Black segregation was associated with a 12% higher hazard of developing CVD after adjusting for demographics (95% Confidence Interval (CI): 1.02, 1.22). This association persisted after adjustment for neighborhood-level characteristics, individual socioeconomic position, and CVD risk factors (HR: 1.12; 95% CI: 1.02, 1.23). For Whites, higher White segregation was associated with lower CVD risk after adjusting for demographics (HR: 0.88; 95% CI: 0.81, 0.96), but not after further adjustment for neighborhood characteristics. Segregation was not associated with CVD risk among Hispanics. Similar results were obtained after adjusting for time-varying segregation and covariates.
Conclusions—The association of residential segregation with cardiovascular risk varies according to race/ethnicity. Further work is needed to better characterize the individual- and neighborhood-level pathways linking segregation to CVD risk.
- Received May 22, 2014.
- Revision received October 1, 2014.
- Accepted October 17, 2014.